More than 1 in 4 births in the United States are unintended. Some of these are unwanted, even to the point of seeking termination yet being unable to do so. Yet despite having a pregnancy that is unplanned or unwanted, most women who find themselves in this situation nonetheless quit or reduce their alcohol consumption.

In the first study of its kind, researchers followed 956 women who sought to terminate their pregnancies across 30 sites in the United States and compared them with women who had wanted their pregnancies. About half of all women in the study drank alcohol in the month before they realized they were pregnant. It was reassuring however, that women with unwanted pregnancies appeared to consume about the same amount of alcohol as pregnant women over all. Once the women with unwanted pregnancies learned they were pregnant, they seemed to follow the behaviors common among other pregnant women: they reduced or quit drinking. Among the 182 women denied termination, 71% quit and 14% reduced drinking.

In an intriguing twist, though, a subgroup of women increased their drinking, apparently substituting alcohol for drug use. It could be that the women using drugs believed that alcohol was a less harmful exposure to a developing fetus, noted the researchers. Ironically, however, maternal alcohol use during early pregnancy is associated with greater harm to the fetus than is marijuana use. Women who drink in early pregnancies deliver babies with lower birthweight. In contrast, marijuana use during pregnancy has not been shown to be associated with fetal harm.

One fourth of the women with unwanted pregnancies had had high rates of binge drinking—at least 6 drinks in a single session, reaching a blood-alcohol content of at least 0.08 percent—before they recognized that they were pregnant. These women were also more likely to use tobacco products, have a history of being physical assaulted, and have earned a college degree. These women were also more likely to continue to drink, even binge drink during their pregnancies, than were women who had not binged. About 5 percent had reported having blackouts during their binge drinking episodes in the month before learning they were pregnant.

A woman who drinks heavily during pregnancy puts her fetus at risk of fetal alcohol syndrome and other spectrum disorders, including growth disorders, birth defects, and cognitive and behavioral impairment. The Centers for Disease Control and Prevention advises that pregnant women abstain from any alcohol. The agency makes the same recommendation to sexually active women who are not using birth control and therefore at risk of pregnancy.

Contraceptive Technology

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This month’s clinical pearl

December 2018 Clinical Fact:

“Because implants and IUDs are highly effective, they are excellent choices for the short-term, too, and the fact that an implant or an IUD is good for “up to” 3 to 20 years is an added advantage but not always relevant.” — Contraceptive Technology, 21st edition